Chronic Pain and Ultrarapid Opioid Detoxification

Abstract

Availability of opiate substances through physicians and on the street has led to a rise in dependence and in addiction resulting in countless numbers of people hooked on these drugs. Long-term use of these agents results in reduction of endogenous supply of opiate replaced by these exogenous compounds. A technique known as Ultrarapid Detoxification (UROD) has been developed and appears more promising than conventional modalities. UROD has been modified over 3 decades resulting in a safe and an effective general anesthetic that results in hemodynamically stable withdrawal without manifestation of central nervous system hyperarousal. A cornerstone of this technique involves clonidine, which stimulates reuptake of catecholamines and allows for large doses of opioid antagonist to be delivered without significant changes in heart rate or blood pressure, displacing the opiate. Though techniques vary from center to center, safety should be paramount with the technique performed in an intensive care unit with trained professional anesthesiologists. Psychosocial issues should be evaluated by a trained addictionalist and most people will succeed from the UROD procedure without experiencing the horrible withdrawal syndrome. Patients must have realistic goals and be prepared to deal with psychosocial issues post-procedure.

Long-term Safety and Tolerability of Tapentadol Extended Release for the Management of Chronic Low Back Pain or Osteoarthritis Pain

“…The primary objective of this study was to evaluate the safety of twice‐daily doses of tapentadol ER (100 to 250 mg) over 1 year. Safety and tolerability assessments included adverse event (AE) reporting, vital signs measurements, physical examinations, clinical laboratory tests, serial electrocardiograms, Patient's Assessment of Constipation Symptoms (PAC‐SYM), 20 the Clinical Opiate Withdrawal Scale (COWS), 21 and the Subjective Opiate Withdrawal Scale (SOWS) 22,23 questionnaires. AEs were recorded from the signing of informed consent through the follow‐up period.…”

“…The severity of opioid withdrawal is categorized according to the sum of the 11 items (maximum score 48) as follows: no withdrawal, <5; mild withdrawal, 5 to 12; moderate withdrawal, 13 to 24; moderately severe withdrawal, 25 to 36; or severe withdrawal, >36. The SOWS questionnaire 22,23 is a 16‐item, self‐reported measure of perceived opioid withdrawal. An abbreviated 15‐item version (deemed more appropriate for this study population) was used in this study.…”

Opioids and clonidine modulate cytokine production and opioid receptor expression in neonatal immune cells

“…Clonidine, an α 2 -adrenergic receptor agonist, prevents the immunomodulatory effects reported with morphine withdrawal in animals 8, 64 . In human adult whole blood and in cord blood MNC, clonidine also stimulates production of the anti-inflammatory cytokine, IL-10, while decreasing the production of the pro-inflammatory cytokine, TNF-α 7, 38 .…”

Opioid-Free Balanced Anesthesia for Cervical Ganglionectomy Subsequent to Recent Ultra Rapid Opioid Detoxification

“…UROD was conceived and has developed over the past three decades in response to the challenge in treating opioid‐dependent patients and is heralded as a humane, effective way to rapidly accomplish detoxification while avoiding the physical symptoms of withdrawal [5]. UROD has been shown to be as effective as intensive inpatient detoxification [2,6–8]. Dropout rates after methadone substitution have been shown to be as high as 30–90% [2,6–8].…”